Basic Information
| Provider Information | |||||||||
| NPI: | 1053504985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMISTEAD | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | PIERCE | ||||||||
| NamePrefix: | MS. | ||||||||
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| OtherLastName: | PIERCE | ||||||||
| OtherFirstName: | JILL | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MA CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 365 SADDLEBROOK CIR | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270238213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366864600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 185 CHARLOIS BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271031521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367250222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7530 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.